Which first-line medications are recommended for the management of trigeminal neuralgia in primary care?

In primary care, the recommended first-line medication for the management of trigeminal neuralgia is carbamazepine. This is the initial treatment of choice due to its established efficacy and safety profile, as advised by NICE guidelines on neuropathic pain management in non-specialist settings. Carbamazepine should be prescribed following MHRA safety advice, particularly regarding its use in pregnancy and monitoring for adverse effects.

If carbamazepine is not effective, not tolerated, or contraindicated, the guidelines recommend seeking specialist advice and considering early referral to a specialist pain or condition-specific service rather than switching to alternative first-line agents in primary care.

While other neuropathic pain medications such as amitriptyline, duloxetine, gabapentin, and pregabalin are commonly used for neuropathic pain, they are not recommended as first-line treatments for trigeminal neuralgia in primary care settings.

Recent clinical research, such as the phase IIa randomized withdrawal study evaluating CNV1014802, a novel sodium channel blocker, suggests potential future alternatives for trigeminal neuralgia treatment; however, these are not yet established or recommended in current primary care guidelines.